103 research outputs found
Numerical study and ex vivo assessment of HIFU treatment time reduction through optimization of focal point trajectory
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Results of surgical resection in stage IIIB non small cell lung cancer(nsclc) after concomitant induction chemoradiotherapy
No full textStereotactic body radiotherapy for central lung tumours: Author reply
No full textPMID: 26151618 To the Editor,We would like to thank Dahele et al1 for addressing the important issue of the accurate definitions of central lung tumours in their letter entitled “Stereotactic body radiotherapy for central lung tumours”. We absolutely agree with the authors regarding the importance of distinguishing between “moderately central” and “very central” lung tumours. The EORTC 22113-08113 LungTech trial only allows the inclusion of patients with moderately central locations. Patients with tumours with very central locations, e.g. adjacent to the oesophagus or overlapping the central airways and for whom dose constraints cannot be achieved, are explicitly excluded.2The dose and fractionation used in the LungTech trial is derived from the important and promising data from VU University Medical Center, Amsterdam, Netherlands.3 Implementing the dose constraints in our trial, those routinely used at the VU University Medical Center have been considered; however, not all of their constraints have been adopted. Thus, whereas the VU used 8 × 5.5 Gy to a maximum point dose,3 the central airway constraint provided in our article (eight fractions of 5.5 Gy to 0.5 cm3)2 refers to the LungTech trial only. We apologize for the misunderstanding and that the constraint for the central airway was not clearly quoted in table 1 of our review.2One of the aims of LungTech is to define the therapeutic limits for moderately central lung tumours. Therefore, details as to how the organs at risk are defined and delineated and which dose–volume histogram parameters are used may have a large influence on local control and toxicity. For this very reason, within the LungTech trial, we are implementing a rigorous radiation therapy quality assurance program. We are conducting delineation training sessions, and we will be collecting all planning data and cone beam CT data. This will enable us to calculate the actual given dose and may help us to find better normal tissue complication probability and tumour control probability model parameters.We agree with Dahele et al that it is important to explicitly define and distinguish tumour location in order to prevent transfer of the results from moderately central to very central tumours and thus potentially avoid severe toxicity. Unfortunately, in the currently available literature on stereotactic body radiation therapy (SBRT) for central tumours, the anatomical description of tumour location is generally not sufficient to categorize tumours in moderately central and very central. Such clear definitions as recently provided by Chaudhuri et al4 are essential to ensure the safety of SBRT. We are therefore very grateful to Dahele et al for describing the general selective approach to central lung SBRT at their centre, e.g. applied in the cohort published by Haasbeek et al.3 They stated that “patients are not excluded from receiving eight-fraction lung SBRT”, even if “there is overlap between the planning target volume (PTV) and selected central structures”. In these cases, “Dose reductions of the PTV to spare overlapping critical structures were not used”.3 On the other hand, we also learn from Dahele's letter that in clinical practice, they were rather conservative in exposing the most central portion of the airways to the full dose, thus including only a very small number of patients with very central tumours in their cohort.However, where does “being conservative” start? Where is this explicit border to too central tumours? And if we exclude them from SBRT with 8 × 7.5 Gy, even in trials, how shall we treat them? Even Chaudhuri et al4 explicitly excluded the oesophagus abutting tumours as well as tumours that were within the mediastinum from the group of “ultra central” lung tumours with gross tumour volumes abutting the proximal bronchial tree or trachea.We acknowledge that the LungTech will not provide data on the safety of treating very central lung tumours with SBRT. Therefore, we strongly support any initiative to set up prospective trials for this group of patients, e.g. in a dose escalation Phase I setting with meticulous toxicity follow-up and/or in comparison with conventionally fractionated radiotherapy.REFERENCESSection:1 . Dahele M, Tekatli H, Senan S. Stereotactic body radiotherapy for central lung tumours. Br J Radiol 2015; 88: 20150410. doi: 10.1259/bjr.20150410 AbstractOpenURL University of Manchester, John Rylands University Library2 . Adebahr S, Collette S, Shash E, Lambrecht M, Le Pechoux C, Faivre-Finn C, et al. LungTech, an EORTC phase II trial of stereotactic body radiotherapy for centrally located lung tumours—a clinical perspective. Br J Radiol 2015; 88: 20150036. doi: 10.1259/bjr.20150036 Abstract, MedlineOpenURL University of Manchester, John Rylands University Library3 . Haasbeek CJ, Lagerwaard FJ, Slotman BJ, Senan S. Outcomes of stereotactic ablative radiotherapy for centrally located early-stage lung cancer. J Thorac Oncol 2011; 6: 2036–43. doi: 10.1097/JTO.0b013e31822e71d8 CrossRef, Medline, ISIOpenURL University of Manchester, John Rylands University Library4 . Chaudhuri AA, Tang C, Binkley MS, Jin M, Wynne JF, von Eyben R, et al. Stereotactic ablative radiotherapy (SABR) for treatment of central and ultra-central lung tumors. Lung Cancer 2015; 89: 50–6. doi: 10.1016/j.lungcan.2015.04.014 CrossRef, Medline, ISIOpenURL University of Manchester, John Rylands University Librar
Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient data
No full textMany randomised controlled trials have investigated the effect of adjuvant chemotherapy in operable non-small-cell lung cancer. We undertook two comprehensive systematic reviews and meta-analyses to establish the effects of adding adjuvant chemotherapy to surgery, or to surgery plus radiotherapy
Cellular-Localization of the Growth-Hormone Receptor/binding Protein in the Human Anterior-Pituitary Gland
No full textThe increasing use of GH therapy has led to the description of its target cells in human tissues, but no data are yet available on the localization of the GH receptor in the human pituitary. In the present study, we used immunocytochemistry to detect the presence of GH receptor/binding protein (GHR/BP), and we examined its distribution among the different types of human anterior pituitary cells. Human pituitaries were taken from autopsies and were processed for embedding in parafin wax. Immunocytochemistry was performed by using monoclonal antibody 263 raised against purified rat and rabbit GHR/BP, which cross-reacts with the human GH receptor. In order to determine the types of cells that display immunoreactivity for GHR/BP, adjacent pituitary sections were used to detect immunoreactivity for GH, PRL, ACTH, TSH, LH, and FSH. Several controls were carried out to verify the specificity of the immunostaining. Receptor immunoreactivity was found in the cytoplasm and nuclei of the somatotrophs, lactotrophs, and gonadotrophs but not in the thyrotrophs or corticotrophs. In order to demonstrate that the detected GHR/BP immunoreactivity was not caused solely by a cellular capture, we also investigated the cellular distribution of GHR gene expression. This was performed by in situ hybridization with use of complementary oligonucleotidic radioactive probes encoding distinct domains of the GHR. Several tests were carried out to validate the detection of gene expression. In situ hybridization demonstrated the presence of GHR messenger RNAs in the anterior lobe of human pituitary, and examination of the signal strengthened the cell-specifity of GHR gene expression. These results demonstrate the presence of GHR/BP in discrete human pituitary cells and indicate a paracrine, autocrine, or intracrine role for GH in the pituitary
Apparel size and fit A critical appreciation of recent developments in clothing sizes
No full textSIGLEAvailable from British Library Document Supply Centre-DSC:8805.700(vol 32 no 1) / BLDSC - British Library Document Supply CentreGBUnited Kingdo
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